Hydatid Cyst of the Cerebellopontine Angle.

Hydatid disease is caused by Echinococcus granulosus. The liver is the first organ of entry, while the central nervous system is affected in about 2% of cases. Primary brain hydatid cyst is extremely rare. The cysts are generally located in cerebral lobes. Here, we reported a 68-year-old Syrian immigrant woman with hydatid cyst in the left cerebellopontine angle. The patient presented gait disturbance, asymmetrical palatal arcs, negative gag reflex, and disturbed cerebellar tests on the left side. The patient was operated via suboccipital craniotomy. The cyst ruptured during manipulation, but it was totally removed.

Aneurysmal Bone Cyst in a Renal Transplant Patient.

Aneurysmal bone cysts constitute 1% to 2% of all primary bone tumors.They are rapidly growing benign bone tumors. Nearly 80% of aneurysmal bone cysts occur in the first 20 years of life, and most are primary tumors. Aneurysmal bone cysts are mostly benign, locally aggressive, and highly vascularized tumors. Generally, the period required for postoperative recovery and new bone formation is long. The relapse rate can be up to 50%. Although computed tomography and magnetic resonance imaging scans are the preferred diagnostic methods, biopsy is the most necessary prerequisite to confirm diagnosis, as aspects of these cysts can show similarity to many other bone lesions. Correct histopathologic diagnosis is important since malignancies may be seen in transplant recipients.

Cervical Spinal Ependymoma With Hemorrhage in a Renal Transplant Patient.

Ependymomas are the most common intramedullary spinal tumors in adults and constitute around 20% of all spinal tumors in adults. There are 3 subgroups of ependymomas according to World Health Organization classification: subependymoma or myxopapillary (grade 1), ependymoma (grade 2), and anaplastic (grade 3). Therapy for patients is aimed at safe and total surgical removal and, in selected cases, postoperative radiotherapy. Bleeding from a spinal ependymoma, with subsequent urgent surgery, is extremely rare. Here, we present a case of a renal transplant patient who had a cervical ependymoma. Although a considerable volume of peritumoral blood was observed during surgery, the patient had no neurologic deficits and no signs of deterioration.

Radiofrequency facet joint neurotomy in treatment of facet syndrome.

STUDY DESIGN: Retrospective analyses of 50 patients with lumbar facet syndrome treated with lumbar facet joint neurotomy. OBJECTIVE: To establish the efficacy of lumbar facet joint neurotomy under optimum conditions in selected patients. SUMMARY OF BACKGROUND DATA: With the realization of the significance of facet joints in the etiology of chronic low back pain over the last decade, many studies were conducted about various methods of treating the facet joint syndrome. METHODS: Fifty patients with lumbar facet syndrome with at least 80% pain relief by controlled, diagnostic medial branch blocks underwent lumbar facet joint neurotomy. Before surgery, all were examined carefully both clinically and radiologically and evaluated by visual analog scale (VAS) and descriptive system of health-related quality of life state (EQ5D) measures of pain, disability, and treatment satisfaction. All outcome measures were repeated postoperatively and at 12 months after surgery. RESULTS: Of the 50 patients 35 were females and 15 were males with a mean age of 51.82±16.99 years. One level was treated in 26 patients, 2 levels in 14, 3 levels in 8, and 4 levels were treated in 2 patients. Symptom duration was ranging between 2 and 24 months with a mean of 7.64±5.98 months. Mean preoperative, postoperative, and at the 12th month VAS were 75.2±11.29, 23.8±10.28, and 24.6±11.817, respectively.Forty-eight percent of patients obtained a relative reduction of at least 70% in VAS, and 86% obtained a reduction of at least 60% at the 12th month. Health-related quality of life state was improved in all patients. When the VAS scores were evaluated with respect to the ages of patients, level numbers, and preoperative symptom duration, no significant differences were found, [0.106, 0.635 and 0.526 (preoperative VAS); 0.033, 0.555, and 0.235 (postoperative VAS); 0.701, 0.978, and 0.155 (follow-up VAS), respectively]. CONCLUSIONS: The most important factors determining success of this procedure is strict patient selection criteria and technique of the procedure.

Ruptured intradiploic dermoid cyst overlying the torcular herophili.

We present a 22-month-old boy with a ruptured dermoid cyst overlying the torcular herophili. The cyst had caused scalp erosion and a lytic bone lesion and was successfully excised surgically. The general features of these cysts are discussed, along with the surgical procedure and implications of cyst rupture.

Rare lesions of the cerebellopontine angle.

Vestibular schwannomas, meningiomas and epidermoids account for a vast majority of the lesions occurring in the cerebellopontine angle (CPA). Neoplastic and non-neoplastic pathologies other than these tumors constitute 1% of all lesions located in the CPA. The aim of this study was to reveal our experience in the treatment of the rare lesions of the CPA. We have retrospectively reviewed the medical files and radiological data of all patients who underwent surgery involving any kind of pathology in the CPA. We have excluded those patients with a histopathological diagnosis of meningioma, schwannoma and epidermoids. Our research revealed a case of craniopharyngioma, a case of chloroma, a case of solitary fibrous tumor, a case of pinealoblastoma, a case of atypical teratoid rhabdoid tumor, a case of an aneurysm, a case of hemorrhage and a case of abscess.

Radiofrequency thermocoagulation of ganglion impar in the management of coccydynia: preliminary results.

AIM: Coccydynia is a painful condition affecting quality of life. The majority of patients can be successfully treated by non-surgical means. Chemical neurolysis, cryoablation and radiofrequency thermocoagulation (RFT) of ganglion impar are also used in the treatment of visceral pelvic pain. We analyzed the efficacy of RFT of ganglion impar in patients with chronic coccydynia. MATERIAL AND METHODS: We retrospectively analyzed the collected data of 10 patients with chronic coccydynia (pain>6 months) who were treated by RFT of the ganglion. RESULTS: The mean age of the patients was 49.2+/-14.4 (range 27-77) with 8 females (80%) and 2 males (20%). The average follow-up duration was 9.1+/-1.2 months. Statistically significant differences were observed between the preprocedure and post-procedure VNSs (p<0.01). Improvements in VNS scores were correlated with improvements in the EQ-5D scores. Midterm evaluation after the treatment (6 months) revealed that 90% of the patients had a successful outcome and 10% were deemed failures. CONCLUSION: Our data suggest that RFT destruction of ganglion impar in patients with chronic coccydynia has an effective outcome and patients responding to RFT have significantly lower post-RFT pain scores. The most important factors determining success of this procedure is strict patient selection criteria and the technique of the procedure.

Placement of three-pin head holders in the Concorde position.

AIM: To reevaluate the Concorde position with different surgical interventions to the posterior fossa and cervical pathology and to improve patient comfort in the Concorde position through obtuse angle placement of the three-pin holder while the patient is in the supine position. MATERIAL AND METHODS: Twenty-nine patients with posterior fossa pathology or cervical pathology were included in this study. All patients were operated in the Concorde position. The three-pin holder was placed with an obtuse angle while the patient was in the supine position as shown in figure 1a. The angle between the handle of the three-pin holder and the floor was measured in the supine and prone positions as shown in Figure 1A,B. RESULTS: The average angle between the floor and the handle of the three-pin holder in the supine position and the Concorde position was 135 degrees (SD +/- 5.45) and 95 degrees (SD +/- 3.26) respectively (Figure 4) All the patient's body including the shoulders was within the borders of the operation table. CONCLUSION: The placement of three-pin holders with an obtuse angle in the supine position provides three advantages: easier manipulation during neck flexion especially for cervical vertebral pathology, much less body weight loading on the three-pin holders during surgery, and less flexion of the neck to expose pathology located in the cervical or posterior fossa region.

The effect of repetitious concussions on cognitive functions in rats.

AIM: In this study, we aimed to investigate the effect of repetitious concussions on the spatial learning and memory function in rats. MATERIAL AND METHODS: 46 adult, male Sprague-Dawley rats were assigned to three homogenous groups by stratified random sampling according to their basal performance during the first four days of the Morris water maze (MWM), as Control (n=10), Sham (n=10) and Concussion (n=26) groups. On the 12th day, the MWM experiment was repeated to evaluate the memory function. Rats in the concussion group were then subjected to the first head trauma. Some of the trauma-applied rats were sacrificed for histopathological examination 4 hours (n=4) and 24 hours (n=3) after the trauma. The spatial memory function of the rest of the rats was re-evaluated by MWM on the 20th day. Some of the rats were then subjected to the second head trauma (n=13), four of which were then sacrificed at the 4th hour, and three of which were sacrificed at the 24th hour. On the 27th day, six rats that had received single concussion and the remaining six that had received two concussions were re-evaluated for retention development by the third MWM experiment. RESULTS: Escape latency curves showed a decrease in Sham and Control groups on the 20th and 27th days, and an increase in concussion group on the 20th day but no statistical significance was found between the groups. CONCLUSION: Repetitious concussions did not significantly affect spatial learning-memory functions in rats, and may lead to a counter-adaptive mechanism against concussive injury.

Donor Safety, Risks, and Complications in Solid-Organ Transplant.

We conducted a literature search on the status of living donors, donor health, and risks of donations in living liver, kidney, pancreas, lung, and small intestine donors. The literature search was made using the PubMed database and the following key words: living donor, transplantation, liver, kidney, lung, pancreas, and small intestine. We found that living donors have a generally favorable outcome; however, follow-up should not be limited to 2 years since some com-plications may be seen in later years. Systems should be developed for early detection of problems, and future research should be directed to nonhuman sources for the treatment of end-stage solid-organ diseases.

Balloon Kyphoplasty Is a Safe and Effective Option for the Treatment of Vertebral Compression Fractures in Solid-Organ Transplant Recipients.

OBJECTIVES: Solid-organ transplant recipients are at great risk for osteoporotic vertebral compression fractures because of both underlying pretransplant bone diseases and posttransplant immunosuppressive treatments. Balloon kyphoplasty is a minimally invasive procedure that is used to treat painful osteoporotic vertebral compression fractures. It involves injection of polymethylmethacrylate into the vertebral body to stabilize the fracture and to alleviate the pain immediately. In this study, we report the results of balloon kyphoplasty for treatment of vertebral compression fractures in solid-organ transplant recipients. MATERIALS AND METHODS: We retrospectively reviewed 512 liver transplant and 2248 kidney transplant procedures that were performed in our center between 1985 and 2015. Seven transplant recipients with a total of 10 acute, symptomatic vertebral compression fractures who were unresponsive to conservative treatment for 3 weeks underwent balloon kyphoplasty. Clinical outcome was graded using the visual analog scale. Radiographic evaluation included measurement of the segmental kyphosis by the Cobb method. RESULTS: There were 4 female and 3 male patients in our study group. Ages of patients ranged from 56 to 63 years with an average age of 58.8 years. The affected vertebral levels varied from T12 to L4. Mean follow-up after balloon kyphoplasty was 3.4 years, and mean time interval from transplant to balloon kyphoplasty was 8.6 years. Statistically significant difference is evident 3 years after transplant surgery (P < .05). Sagittal alignment improved (> 5 degrees) in 2 of 7 patients (28%). CONCLUSIONS: Transplant recipients are at great risk in terms of vertebral compression fracture development, especially within 1 year after transplant. Although conservative treatment has been the first treatment choice for vertebral compression fracture, long treatment time and high costs may be needed to achieve cure. Experience with our small patient population showed that balloon kyphoplasty was effective and safe for obtaining rapid pain relief and earlier mobilization with fewer complications.

Can subdural hematoma be a trigger for Guillain-Barré syndrome?

Guillain-Barré syndrome (GBS) is an acute inflammatory polyneuropathy which follows a precipitating event in approximately two thirds of cases. Although its pathogenesis is unclear, it is likely to be a consequence of an immune-mediated process. In the literature there are three case reports of GBS following subarachnoid hemorrhage, subdural hematoma, and facial bone fracture after head trauma.The unique feature of our case with GBS after subdural hematoma is the presence of cerebellar symptoms. We believe that GBS results from an aberrant immune response following trauma that somehow mistakenly attacks the nerve tissue of its host, and we discuss the effects of the trauma of head injury on cellular and humoral immunities and the absence of antiganglioside antibody (anti-GD1b IgG, which is accused of ataxia and cerebellar symptoms) in this case report.

Her-2/neu gene amplification in paraffin-embedded tissue sections of meningioma patients.

AIM: Meningiomas arise from the meningoendothelial cells and are one of the most common tumors of the central nervous system. The HER-2/neu gene is located on the 17q11.2-q12 chromosome region and encodes an epidermal growth factor receptor. HER- 2/neu gene amplification and/or over expression have been studied most widely in breast carcinomas. Previous studies have shown the importance of HER-2/neu gene amplification on the prognosis of meningioma cases. In this study, we aimed to detect HER-2/neu gene copy number in archive materials of 55 meningioma patients by fluorescent in situ hybridization (FISH). MATERIAL AND METHODS: The patients included in the study had undergone surgery in the neurosurgery department of our hospital between 1999 and 2002. Tissue samples were classified histologically according to WHO 2007 guidelines. Interphase FISH was performed on 3 to 4microm thick paraffin embedded tissue sections for the detection of HER- 2/neu gene amplification status. RESULTS: We found HER-2/neu gene amplification in 7 (12.73%) patients. Another 2 patients had only one signal for the HER-2/neu region. We confirmed this finding by a second hybridization with the chromosome 17p13.1 (p53) probe. CONCLUSION: According to our results, HER-2/neu amplification could be regarded as an additional genetic factor playing role in meningioma pathogenesis together with known chromosomal abnormalities.

Predictive value of leucocytosis in head trauma.

AIM: Head trauma is associated with an acute phase response which is characterized by leucocytosis due to increased levels of catecholamine and cortisol. Early edema formation following severe head injury may also be associated with microglia activation. Therefore, increased white blood cell (WBC) count after head trauma may be a predictive parameter of the severity of craniocerebral trauma. MATERIAL AND METHODS: We retrospectively studied 59 patients with severe, moderate and minor injury between February 2007 and March 2009. WBC counts of all patients were obtained within the first day of their admission. All patients were divided into separate groups according to their Glasgow Coma Scale (GCS) scores and hospital stay durations. Their CT progressions and Glasgow Outcome Scale (GOS) scores were also assessed. The relationship between these parameters and WBC counts were evaluated by statistical methods. RESULTS: There was a favorable correlation between WBC counts of the patients and GCS scores (pI0.01), hospital stay (p=0.006), CT progression (p < 0.01) and GOS scores (p < 0.01). CONCLUSION: AWBC count exceeding 17.5 x 106/l has a predictive value for poor GCS score, and long hospital stay. CT progression tends to be seen in patients with moderate and severe head injury.

Osteoid osteoma in the thorasic spine.

Osteoid osteoma is a benign skeletal neoplasm composed of osteoid and woven bone. The majority of the lesions arise in the cortex of long bones. Osteoid osteoma of the spine is a rare primary spine tumor and those located at the thoracal spine are even rarer. The usual treatment involves complete resection, including the nidus, or alternatively radiofrequency percutaneous ablation is performed. The authors present a 32-year-old female with an unusual localization of the osteoid osteoma in the thoracal spine where imaging modalities were not conclusive for the diagnosis. The T1 vertebra lesion was successfully resected via a posterior approach with T1 laminectomy, including right side C7 and T1 foraminotomies, and vertebroplasty were performed. Histopathology reported the lesion as an osteoid osteoma.

Analysis of serum pro-inflammatory cytokine levels after rat spinal cord ischemia/reperfusion injury and correlation with tissue damage.

AIM: A rat model of spinal cord ischemia/reperfusion was conducted and the serum cytokine levels and histopathological changes were assessed. MATERIAL AND METHODS: Twenty-four male Sprague-Dawley rats were assigned into four experimental groups. Group-A (the sham operated rats) and group-B (the spinal ischemia/reperfusion group) were sacrificed at 24 hours postoperatively while group-C (the sham operated rats) and group-D (the spinal ischemia/reperfusion group) were sacrificed at 48 hours. Histopathological changes in the spinal cords and serum cytokine levels were analysed. RESULTS: All three proinflammatory cytokine levels reached significantly higher levels compared to the sham operated groups in both the 24-hour and 48-hour spinal cord ischemia/reperfusion groups. CONCLUSION: Inflammation is a plausible pathway in spinal cord ishemia/reperfusion injury. However clinical treatment of the damage does not currently include antiinflammatory therapy. The results of our study supported the hypothesis that inflammatory responses could play a possible role in the ischemia/reperfusion injury of the spinal cord. Characterization of the role of inflammation in the etiopathogenesis of ischemia/reperfusion injury to the spinal cord is important to facilitate the development of novel therapeutic approaches for prevention and/or treatment of this severe condition.

The preventive effect of mexiletine on cerebral ischemic injury following experimental middle cerebral artery occlusion.

AIM: Previous studies demonstrated that mexiletine has some important features in the prevention of ischemic brain injury such as sodium and calcium canal blockage and free radical occurrence. Our aim was to investigate the effects of mexiletine on ischemic brain injury. MATERIAL AND METHODS: Experiments were performed on 30 adult male Sprague- Dawley rats (285-425 g). Left middle cerebral artery occlusion following microcraniectomy and simultaneous bilateral carotid artery occlusion were performed. Three different treatments were included in this study: (a) "naïve" control group (no drug applied; n = 10); (b) "sham surgery" control group (only saline was applied; n = 10); and a (c) "treatment group (n = 10) where mexiletine was applied. After 24 h from ischemic insult, all rats were decapitated and prepared for immunocytochemical and histopathological analyses. Cerebral infarct volumes were calculated and compared using ANOVA and a Post- Hoc Bonferroni test in each group statistically. RESULTS: The results showed statistically significant differences between the treatment (81.98 +/- 12.58 mm?), control (121.57 +/- 11.41 mm?) and sham (116.08 +/- 12.36 mm?) groups (p < 0,0001), respectively. CONCLUSION: Mexiletine should be considered as an alternative medication for prevention and treatment of ischemic brain injury due to its multipotent effects.

Microsatellite Instability in Glioblastoma: Is It Really Relevant in Tumor Prognosis?

AIM: To evaluate the frequency and prognostic significance of microsatellite instability (MSI) in patients with glioblastoma (GBM), an immunohistochemical analysis of mismatch repair (MMR) proteins was performed. MATERIAL AND METHODS: A total of 71 patients with GBM who underwent surgery between 2011 and 2019, were included in the study. MMR protein expression was examined using immunohistochemistical analysis of tumor tissue samples; the association between the MMR status and clinicopathological findings was evaluated. RESULTS: Immunohistochemical analysis revealed expressions of MLH1, MSH2, MSH6, and PMS2 proteins in 67 (94.4%), 65 (91.5%), 67 (94.4%), and 64 (90.1%) patients, respectively. Among the 71 patients, 64 (90.1%) expressing all MMR proteins were considered microsatellite stable (MSS), and 7 (9.9%) patients showing loss of at least one of the MMR proteins were considered to show MSI. Tumor recurrence was noted in 25 (39.1%) patients in the MSS GBM group, and 4 (57.1%) patients in the MSI GBM group (p=0.433). The overall median survival was 30.65 ± 5.1 and 10.71 ± 5.2 months in the MSS GBM and MSI GBM groups, respectively (p=0.059). CONCLUSION: The results of this study showed no significant relationships between MMR protein expression and recurrence rates or overall survival in patients with GBM.

Prognostic significance of third ventricle dilation in spontaneous intracerebral hemorrhage: a preliminary clinical study.

OBJECTIVE: Although numerous factors have been described that predict outcome after spontaneous intracerebral hemorrhage (ICH), very little is know about the role of hemorrhagic dilation of the third ventricle in development of hydrocephalus and prognosis. The objective of this study was to investigate whether the presence of hemorrhagic third ventricle dilation after ICH would predict development of hydrocephalus and outcome. METHODS: We identified the patients with spontaneous ICH treated with external ventricular drainage (EVD) in this retrospective study. Computerized tomography (CT) was performed at admission within 24 hours of onset and retrospectively analysed to determine lesion size and location, status of third and fourth ventricle and frontal horn index (FHI). Glasgow coma scale (GCS) score, mean arterial pressure (MAP), etiology and demographic data were obtained from medical records. Outcome was determined using modified Rankin score at month 3. Patients with and without third ventricle dilation were compared in terms of hydrocephalus (FHI > 0.38), initial GCS score, age and MAP, and analyses were performed to determine whether third ventricle dilation was a predictor of poor outcome. RESULTS: Of the 22 patients studied, all had thalamic or basal ganglia hemorrhage with intraventricular hemorrhage (IVH) and all are treated with external ventricular drainage (EVD). Of the 22 patients, 12 had third ventricle dilation (width > or = 10 mm) and ten patients had non-dilated third ventricle (width < 10 mm). Patients with third ventricle dilation had lower GCS scores (7.4 +/- 1.8 versus 9.7 +/- 2.1, p < 0.005) and had higher FHI (0.46 +/- 0.06 versus 0.38 +/- 0.02, p < 0.005) as compared to patients with non-dilated third ventricle. The differences in age (59.5 +/- 9.4 versus 59.2 +/- 11.2) and MAP (128.3 +/- 16.0 versus 130.5 +/- 13.6) of the patients were not significant statistically. Sixty-six percent of patients (8/12) with third ventricle dilation and 60% of patients (6/10) with normal third ventricle were dead 6 months post-operation and mortality rate did not differ significantly. DISCUSSION: Although the roles of various factors are well described in the prognosis of spontaneous ICH, little is known about the role of third ventricle dilation. Based on our results, we concluded that third ventricle dilation is a poor prognostic factor.

Primary cerebral intraventricular hydatid cyst: a case report and review of the literature.

Intracranial hydatid cysts, which are common in certain areas worldwide, almost always develop at an intraparenchymal site. However, the literature on intraventricular hydatid cysts consists of only 6 independent case reports and about 30 cases that are described in large series. We report on a 10-year-old girl who was admitted with an intracranial cyst. She complained of headache of 10 months' duration that had intensified significantly over the 3 weeks immediately before her admission. The results of a neurologic examination showed bilateral papilledema and slight left hemiparesis. Magnetic resonance imaging revealed a right temporo-parieto-occipital cystic lesion that was causing the shifting of the midline structures to the contralateral side. The giant cyst was successfully removed without rupture. The possibility of infection with Echinococcus granulosus should be included in the differential diagnosis of unspecific neurologic symptoms such as a progressively worsening headache, especially in pediatric patients from the geographic areas in which that parasite is endemic.